Issue Category: Child and School Health

The Nation’s Public Health System is at an Inflection Point

New Report Provides the Next Administration and Congress a Policy Roadmap for Improving the Nation’s Health, Economy, and National Security

(October 8, 2024 – Washington, DC) – The public health system—responsible for protecting and promoting health in every community— needs sustained investment, policy support, and protection from political interference, according to a new report released today by Trust for America’s Health.

The report, Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress, identifies six priority areas and includes policy recommendations that, if adopted, will improve health outcomes and bolster the nation’s economic and national security.

Americans are living longer, thanks in part to public health. Public health interventions, such as improved sanitation, enhanced vaccination access and stronger infectious disease control, improved nutrition, tobacco use prevention, and addressing preventable injury, were the largest contributing factors to life expectancy increases over the last century.

However, too many Americans are still suffering from preventable health problems. Over the last few decades, increasing rates of chronic diseases and alarming levels of substance use disorder and suicides threaten the public’s health. Furthermore, weather-related emergencies are occurring more frequently, and population-level health disparities persist.

Public health is at risk on several fronts. Underfunding has weakened the public health infrastructure and its workforce. Mis- and disinformation and politicization have contributed to distrust of public health officials and guidance. Public health’s ability to protect communities is also at risk due to proposed or enacted policies that undermine the role of public health officials or access to preventive healthcare.

“This Blueprint Report provides a roadmap for the Administration and Congress taking office in January to improve the health and well-being of the nation. We know what works in public health and that when Congress and the Administration act in support of public health, the return is improved preparedness and individual and community health and safety,” said J. Nadine Gracia, M.D. MSCE, President and CEO, Trust for America’s Health. “The next Administration and Congress will have an important opportunity to enable all Americans to enjoy optimal health.”

2024 Blueprint Priority Areas and Highlighted Recommendations

This report includes recommendations across six priority areas to protect and strengthen public health, prevention, and our nation’s health security. The following are highlighted recommendations from the report. See the report for the inclusive set of recommendations.

Priority 1: Invest in Infrastructure and Workforce to Ensure Our Public Health System Can Meet the Challenges and Opportunities of the 21st Century.

  • Congress should protect and increase overall funding for the Centers for Disease Control and Prevention (CDC).
  • Congress should ensure continuous improvement of public health infrastructure.
  • Congress should invest in public health data modernization and enact the Improving DATA in Public Health Act to better detect and contain health threats.
  • Congress and HHS agencies should support efforts to bolster recruitment, retention, and resilience of the public health workforce.

Priority 2: Strengthen Prevention, Readiness, and Response to Health Security Threats.

  • The White House should maintain coordination and leadership around public health emergencies and biodefense, and the White House and Congress should renew the nation’s Global Health Security Commitment.
  • Congress should expand public health emergency preparedness funding for state, tribal, local, and territorial jurisdictions.
  • Congress and the Administration for Strategic Preparedness and Response should strengthen the emergency readiness of the healthcare delivery system.
  • Congress should enact legislation to ensure access to vaccines for uninsured and underinsured adults.
  • Congress should support nationwide efforts to protect against environmental and climate-related health threats, including extreme heat.

Priority 3: Promote the Health and Well-being of Individuals, Families, and Communities Across the Lifespan.

  • Congress should increase funding to CDC’s National Center for Chronic Disease Prevention and Health Promotion.
  • Congress should enhance benefits in and protect access to the Supplemental Nutrition Assistance Program and should make healthy school meals for all permanent.
  • Congress should create a national standard requiring employers to provide job-protected paid sick, family, and medical leave for all employees.
  • Congress and HHS should address Adverse Childhood Experiences (ACEs) by passing the Preventing Adverse Childhood Experiences Act and increasing the investment in the CDC ACEs program.
  • Congress should fund the nationwide implementation of CDC’s Comprehensive Suicide Prevention Program and support Substance Abuse and Mental Health Services Administration’s efforts to bolster the continuum of crisis care.
  • Congress and the Administration should fund CDC’s internal capacity for healthy aging efforts and its support to build and sustain age-friendly public health systems in state, local, tribal, and territorial public health departments.

Priority 4: Advance Health Equity by Addressing Structural Discrimination.

  • Federal agencies should regularly update and report progress on agency equity plans, ensuring metrics are inclusive of and extend beyond tracking disparities.
  • Congress and the Administration should ensure accurate and complete data collection to report health-related information by race/ethnicity, age, sex, disability, language, sexual orientation, gender identity, and geography.
  • Federal health agencies should focus funding on populations at elevated risk for chronic disease and poor health outcomes due to the impact of structural discrimination and disinvestment.

Priority 5: Address the Non-Medical Drivers of Health to Improve the Nation’s Health Outcomes.

  • Congress should increase funding to $150 million for the Social Determinants of Health program at CDC and pass the Improving Social Determinants of Health Act.
  • The Administration should continue to build on the Centers for Medicare & Medicaid Services’ (CMS) efforts to support Medicaid, Medicare, and Children’s Health Insurance Program coverage of patients’ health-related social needs.
  • CMS and Congress should explore opportunities to expand the capacity of healthcare providers and payers to screen and refer individuals to social services.
  • Congress should amend tax laws to increase economic opportunity for families by expanding access to the Child Tax Credit and Earned Income Tax Credit.

Priority 6: Enhance and Protect the Scientific Integrity, Effectiveness, and Accountability of the Agencies Charged with Protecting the Health of all Americans.

  • The Administration and Congress should maintain the existing structure of federal health agencies, which have specific roles and expertise in protecting the nation’s health.
  • The Administration should protect the scientific integrity of public health agencies and leaders.
  • Congress and HHS should invest in and prioritize effective public health communications and reducing the spread of misinformation and disinformation.
  • Lawmakers and courts should reject laws that weaken or preempt public health authorities, which could threaten basic public health protections such as outbreak detection, vaccination, and response.

 

Read the full report

Trust for America’s Health is a nonprofit, nonpartisan public health research, policy, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. 

 

 

National Immunization Month Highlights Lifesaving Benefits of Vaccines

August 2024

National Immunization Awareness Month sponsored by the National Public Health Information Coalition (NPHIC) and observed every August, highlights the lifesaving benefits of vaccines. During the month, activities will raise awareness of the importance of vaccinating people of all ages against serious and sometimes deadly diseases. The awareness month also celebrates the successes of immunizations and educates Americans about vaccine safety and effectiveness.

According to a study by the Commonwealth Fund, from December 2020 through November 2022, COVID-19 vaccines prevented approximately 18.5 million hospitalizations and 3.2 million deaths in the U.S., but the lifesaving impact of vaccines extends far beyond COVID-19. Vaccines have dramatically reduced the spread of diseases like measles, polio, and whooping cough, protecting countless individuals and communities.

According to new data published this month by the CDC, among children born during 1994-2023, routine childhood vaccinations will have prevented about 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths over the course of their lifetimes.

Unfortunately, numerous factors have led to a decline in vaccination rates in recent years including healthcare disruptions during the COVID-19 pandemic and the spread of misinformation about vaccine safety and effectiveness. In some cases, this has resulted in outbreaks of once-controlled diseases, including measles and to a lesser degree polio, jeopardizing the progress we have made.

According to the American Association of Immunologists, getting vaccinated protects against the spread of infectious diseases by helping our immune systems fight infection. Vaccines work by introducing a weakened or inactive form of a virus or bacteria to the body. This triggers the immune system to develop antibodies, creating a kind of shield against future infection. When a large portion of the population is vaccinated, it creates “herd” or community-level immunity, making it difficult for diseases to spread, even protecting those who haven’t been vaccinated themselves.

The public health benefits of vaccines include:

Disease Prevention: Vaccines are highly effective at preventing serious illnesses like measles, mumps, rubella, polio, diphtheria, tetanus, whooping cough, chickenpox, shingles, influenza, and pneumonia. These diseases can cause severe complications, hospitalization, and even death.

Reduced Healthcare Costs: Vaccines are a cost-effective way to prevent illness and its associated medical expenses. Vaccination programs save billions of dollars in healthcare costs each year.

Protection for Populations at Higher Risk: Vaccines are especially important for protecting those with developing immune systems (infants) or weakened immune systems, such as older adults and people with certain chronic illnesses.

Global Health Impact: Vaccination programs have had a significant impact on global health. They have helped to virtually eliminate smallpox and dramatically reduced the burden of other diseases worldwide.

To build on and sustain the health benefits of vaccines, TFAH’s 2024 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report includes a number of important recommended policy actions to strengthen the nation’s vaccine infrastructure:

  • Increased Funding: Congress should provide at least $1.1 billion per year to support vaccine infrastructure and delivery, including programs promoting equitable vaccine distribution.
  • Insurance Coverage: Congress and states should ensure first-dollar coverage for recommended vaccines under commercial insurance and for uninsured populations.
  • Minimizing Exemptions: States should minimize vaccine exemptions for schoolchildren, and healthcare facilities should increase vaccination rates of healthcare workers.
  • New Vaccine Development: Congress should create incentives for new-product discovery to prevent and fight resistant infections including therapeutics, diagnostics, and prevention products such as vaccines.
  • Strengthening Influenza Defenses: Congress should strengthen the pipeline of influenza vaccines, diagnostics, and therapeutics.
  • Countering Vaccine Misinformation:The spread of misinformation about vaccines can lead to vaccine hesitancy and lower vaccination rates. TFAH calls for promoting accurate information from trusted sources to increase vaccine confidence.

According to research published in The Lancet, since 1974, vaccination has prevented 154 million deaths worldwide. By ensuring equitable access to vaccines, promoting accurate information, and investing in research and education, we can continue to harness the power of vaccines and build a healthier future for all.

 

Racial and Ethnic Approaches to Community Health (REACH) Program’s 25th Anniversary

Trust for America’s Health hosted a virtual Congressional briefing and national webinar honoring the 25th anniversary of the Centers for Disease Control and Prevention (CDC) Racial and Ethnic Approaches to Community Health (REACH) program. REACH aims to improve health, prevent chronic diseases, and reduce health disparities among racial and ethnic populations with the highest risk, or burden of chronic disease. Since 1999, the program has empowered communities to develop and share effective solutions, fostering a healthier future for all.

A panel of subject matter experts discussed the history, achievements, and future of the REACH program.

Nutrition Support Programs are Vital to Preventing Food and Nutrition Insecurity and Reducing Chronic Disease – Congress Must Act to Support Them

As of early November 2023, draft appropriation bills by both the House of Representatives and the Senate do not adequately fund the WIC nutrition support program, threatening to break a nearly 30-year, bipartisan commitment to ensure all participants can access the program without waitlists.

(Washington, DC – 11/20/23) – Access to nutritious food is critical to preventing many chronic diseases and is particularly important to keep young children on track with their growth and developmental needs. In 2022, an estimated 12.8 percent of U.S. households experienced food and or nutrition insecurity sometime during the year.
As Trust for America’s Health’s (TFAH) State of Obesity report series has demonstrated, food insecurity is a risk factor for obesity and other nutrition-related chronic diseases. Progress on addressing these critical public health issues is in jeopardy if Congress does not provide funding for federal nutrition support programs during the current fiscal year.
One of the key federal nutrition programs supporting the specific nutritional needs of young children, infants, and birthing people is the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC. Created in 1972, the WIC program is a short-term, public health intervention program designed to strengthen lifetime nutrition and health behaviors within households with low-incomes. The WIC program provides nutrition benefits tailored to support a young child’s development. Over time, the program, including its food packages, has aligned with new science about the key nutrients infants and children need. These changes have had a significant impact. Studies show that the 2007 benefit update helped improve beneficiaries’ diets and decreased rates of obesity among enrolled toddlers ages 2-4.

The WIC program also adapted to challenges created by the COVID-19 pandemic by implementing new flexibilities, such as allowing WIC agencies to remotely load benefits cards. In 2021, Congress also increased the monthly benefit available to families to purchase more fruits and vegetables from $9 to $26 for children, and from $11 to $47 for pregnant and postpartum participants. These changes modernized the program and in turn increased participation; important because WIC has long had lower participation rates in comparison to the number of eligible families.

Today, nearly seven million parents and children under five years old depend on the WIC program, and participation is expected to grow due to increased program flexibilities. To keep up with increased demand, additional program funding is needed. As of early November 2023, draft appropriation bills by both the House of Representatives and the Senate do not adequately fund the WIC program, which threatens to break a nearly 30-year, bipartisan commitment to ensure all participants can access WIC without waitlists. Increasing food costs, make action to grow the WIC program critically important as families are struggling to afford healthy meals and may be forced to turn to cheaper but less nutritious alternatives.

Critical public health programs like WIC not only provide nutritious foods to families in the short term, but also help prevent diet-related diseases. Trust for America’s Health urges Congress to increase funding in the Fiscal Year (FY) 2024 budget for the WIC program to ensure pregnant and postpartum birthing people and their young children have the nutrition they need to enjoy good

August is National Immunization Awareness Month

August is National Immunization Awareness Month. This annual observance is designed to remind everyone that staying up to date on vaccinations is an important way to protect not only their health but the health of everyone around them.

Vaccines are a public health success story. Today, we are fortunate to have a broad spectrum of safe and effective vaccines, which if received on schedule, protect patients of all ages against vaccine-preventable diseases. Current vaccines protect against childhood disease including chicken pox, measles, and whooping cough, while protecting adults from the flu, Tdap, and shingles. Vaccines have also eradicated or nearly eradicated life-threatening diseases, such as smallpox and polio.

Children as young as 1-2 months old should be vaccinated against childhood illnesses and school-age children may need vaccine updates before they can return to school this fall. Ensuring that every child sees their doctor for a well-child visit and to receive any needed vaccine or vaccine updates is one of the best ways a parent can protect their child’s health and that of the community. Because the immunity created by a vaccine can lessen overtime, it’s important that children receive their vaccines on the recommended schedule. Adults may also need vaccine updates or to receive recently approved vaccines such as the RSV vaccine for adults 60 years of age and older.

During the COVID-19 pandemic, routine childhood vaccination levels among school-age children in the U.S. decreased, likely due to missed well-child medical visits. Globally, a report by UNICEF and the World Health Organization found that childhood vaccination coverage worldwide increased with about 4 million more children receiving full immunizations in 2022 compared to 2021, but were still below pre-pandemic levels.

Vaccines meet strict safety and effectiveness measures
In the U.S., safety measures are strict and prioritized to ensure that vaccines are safe for patients. Before any vaccine is approved for use, it is tested for safety and effectiveness through clinical trials and then must be approved by the Food and Drug Administration (FDA) and recommended by the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices. While some people experience mild side effects after receiving a vaccine, such as swelling at the shot area, mild fevers and chills, serious reactions are extremely rare. Overall, the safety of all vaccines is closely monitored to ensure their continued safe use. If patients have questions about a vaccine including any potential side effects, they should speak to their healthcare provider.

Visit the Centers for Disease Control and Prevention website for more information on vaccine safety and for child and adult immunization schedules.

 

 

Over Thirty-Five Health and Child Wellness Organizations Endorse the Improving Data Collection for Adverse Childhood Experiences Act

(Washington, DC – July 11, 2022) – Adverse Childhood Experiences (ACEs) can have long-lasting effects over the lifetime of an individual including negative health impacts. Research shows that the higher the number of ACEs an individual experiences the higher their risk for negative health outcomes like asthma, diabetes, cancer, substance use, and suicide in adulthood. The Centers for Disease Control and Prevention estimate that 61 percent of U.S. adults report having at least one ACE, and that the prevention of ACEs could reduce cases of depression in adults by 44 percent and avoid 1.9 million cases of heart disease.

The Improving Data Collection for ACEs Act is a bipartisan effort to enable the collection of more inclusive data about ACEs. It would support additional research on the impact of ACEs with a focus on understanding of the frequency and intensity of ACEs, the relationship between ACEs and negative health outcomes, and the influence of risk and protective factors.

For more information, contact Brandon Reavis, Senior Government Relations Manager at Trust for America’s Health, [email protected].

The Role of Community Development in Improving Population Health and How Pediatricians Can Help

A research article authored by Build Healthy Places Network and published by Academic Pediatrics, discusses the relationship between the zip code in which a child lives and that communities’ health implications that permeate well into adulthood. This includes the physical environment measured by things like access to healthy food, places to engage in physical activity, sanitation, and the mental and emotional environments including healthy relationships, communication with adults, and connectedness at school.

The effects of the environment in which a child is raised can be exacerbated by adverse childhood experiences (ACEs) like exposure to violence or family instability and can have negative impacts on a child’s health and into adulthood. Thee article reviews the role of pediatricians can play in advocating for community development initiatives that foster healthy neighborhood conditions where children can grow and thrive.

What Is Community Development?

Community development is a multifaceted term that has its origins in the antipoverty and racial justice movements of the 1960s. It partly began as a corrective response to racial segregation and redlining practices in the housing and finance markets that created and perpetuated low-resource neighborhoods. Organizations involved in community development work often focused on building generational wealth and quality of neighborhoods are increased through investments in affordable housing, grocery stores, health clinics schools and childcare centers, and small businesses to provide local jobs. These are direct resources in the community that are also known to have a positive effect on reducing crime, substance misuse, and other risk factors.
The Conway Center in Washington, DC  is an example. The Conway Center provides affordable family housing and housing for individuals experiencing homelessness, green space and a playground, office space, a job raining center, and a community health clinic in a property that is accessible by public transportation. The center has yet to be formally evaluated but the article’s authors advise that when such programs are evaluated the evaluators should measure its impact in ways beyond the traditional measurements of controlled or clinical experiments. For example, measures that capture the real world impact on people’s lives should be employed.

Other examples are the neighborhoods of the Villages at East Lake in Atlanta, GA and Columbia Parc in New Orleans, LA. Both communities were originally public housing projects, that now focus on children’s education and family economic success by prioritizing mixed-income housing, cradle-to=college education, healthy food access, recreation, public safety, and neighborhood services like shopping and banking. Columbia Parc has not been quantitatively evaluated, but the Villages at East Lake, Atlanta, has seen a significant decrease in violent crime, a 5-fold increase in household income, standardized test scores among the top five for K-12 schools in the Atlanta metro area, and a 97% high school graduation rate that was previously under 30% in the 1990s.

How Can Pediatricians Support Community Development?

What a child experiences and its impact on their developing minds and bodies can put them at risk well into adolescence and even adulthood. Interventions are therefore most effective when they target the early stages of a child’s life.

The opportunity to be healthy during childhood is a bridge to other opportunities – for education, emotional well-being and employment, the article states. Promoting health should therefore be a priority consideration for community development, and health experts should be included in the community development process. As experts in child health, pediatricians are uniquely qualified to integrate health as a protective factor in community development efforts. According to the National Academy of Medicine, only 10-20 percent of health status is related to medical care; the rest is accounted for by social determinants of health – opportunities for healthy behaviors like access to healthy food choices and safe and accessible places for physical activity, socioeconomic factors like education and employment,  and physical environment like housing and pollution. It is not just beneficial, but necessary for a physician to consider this holistic and interactive context in which health operates, knowing that health can be modified by any one of these non-clinical factors.

According to the article, a pediatrician therefore has a professional interest in understanding their patients’ family and community characteristics that influence health. Pediatricians’ input can help design community development initiatives that support families and children’s healthy development. Jutte, Badruzzaman, and Thomas-Squance share some tangible ways pediatrician can use their professional voice to drive neighborhood investments through a community development framework.

Next, researchers in the field of pediatrics can investigate the effects of neighborhood investments on child and adolescent health, in one potential way by studying health variables in neighborhoods where investments have already been made but impact has yet to be measured, like the Conway Center.

Policy Action is Needed

The Build Healthy Places Network’s article underscores the need for policy action Community development should be a central value and initiative in improving the health of and preventive services in neighborhoods. Neighborhood infrastructure has lasting effects on children that persist into adulthood, for both risk and protective factors. Pediatric professionals can use their expertise in the field to practice, educate, and advocate for the principles of community development that consider holistic wellness. Trust for America’s Health’s (TFAH) Promoting Health and Cost Control in States (PHACCS) report includes several policy actions that pediatricians can support in order to advance pediatric health:

  • School-based health centers that meet comprehensive pediatric needs in primary care including healthcare, oral care, behavioral healthcare, and health education in fixed, mobile, or telehealth location settings.
  • Early education and universal pre-kindergarten programs that benefit childhood development and reduce the likelihood of risk factors throughout the life course.
  • Housing rehabilitation programs that make physical improvements in neglected properties like lead abatement, re-housing programs that offer support services for individuals experiencing homelessness to transition to permanent housing, and policies that protect the affordability of housing like tax credits and incentives.
  • Developmental infrastructure like “Complete Streets” policies that promote physical activity, safer streets, and mixed-use land spaces that create inclusive, integrative, and healthier neighborhoods for living and growing.
  • Affordable, sustainable quality housing that provides stability, economic and social opportunity for families, and long-term health benefits that are protective factors for life-long wellness.

For more details on these solutions and policies, see TFAH’s PHACCS initiative and accompanying reports.

TFAH Applauds USDA’s Announcement of New Standards Improving Nutrition in School Meals

Actions will Help Address Youth Obesity Crisis

(Washington, DC – February 7, 2022) – The U.S. Department of Agriculture’s recent announcement that the agency will update school meal nutrition standards will help ensure more nutritious school meals for millions of children and adolescents and is an important step toward reversing the nation’s alarming rates of childhood obesity.

The Department announced a stepwise approach, beginning in the next school year. Among the most critical changes are:

  • Beginning in the 2022-2023 school year, requiring that schools and child-care providers serving children ages six and older offer low-fat, flavored milk, nonfat flavored milk, or nonfat or low-fat unflavored milk.
  • Requiring that 80 percent of the grains served in school meals each week are rich in whole grains, beginning with the 2022-2023 school year.
  • Requiring a 10 percent decrease in weekly sodium levels in school meals starting with the 2023-2024 school year.
  • Beginning the process for more permanent nutrition standards for the 2024-2025 school year.

Importantly, these changes will return nutritional standards for school meals to 2012 levels, which have been found to have dramatically increased the quality of students’ nutrition.

Rising obesity rates are a serious problem among children and adolescents nationwide. According to the latest available data, nearly 20 percent (19.3 percent) of U.S. children ages 2 to 19 have obesity. These data more than tripled since the mid-1970s and Black and Latino youth have substantially higher rates of obesity than do their white peers. The racial and ethnic disparities in obesity underscore the need to address social determinants of health, including food insecurity, access to healthy and nutritious foods, poverty, and other systemic barriers to health.

“These changes in school meal nutrition standards are an important step toward addressing America’s childhood obesity crisis. Millions of U.S. children get a significant proportion of their daily food intake via meals served in school. Evidence shows that ensuring that those meals are high in nutritional value will improve children’s health and help with their school performance and readiness to learn,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health.

Learn more about adult and childhood obesity trends and policies to address the obesity crisis in TFAH’s 2021 State of Obesity Report: Better Policies for a Healthier America.